Original Article

The Relationship Between Paternal Postpartum

Depression and Psychosocial Variables:
A longitudinal Study in Iran
Mamak Shariat; M.D.1, Nasrin Abedinia; Ph.D.1, Hasti Charousaei; Ph.D.1, Fatemeh Fatahi; M.Sc.2

1 Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran
University of Medical Sciences, Tehran, Iran
2 Department of Clinical and Health Psychology, Shahid Beheshti University, Tehran, Iran

Received June 2022; Revised and accepted November 2022

Abstract
Objective: This study aimed to investigate and identify the psychosocial factors that are associated with
paternal postpartum depression.
Materials and methods: A longitudinal correlation study with 150 fathers was performed with three time
frames (late pregnancy, postpartum, and four weeks postpartum). The Edinburgh Postnatal Depression
Scale assessed those with depression (38.7%; n=58) and those without depressive symptoms (61.3%;
n=92). Psychological variables related to paternal depression were also assessed through questionnaires.
Results: Psychological variables such as marital adjustment and stress had a significant relationship
with paternal depression. In addition, depressed fathers experienced less marital compatibility and more
tension than non-depressed fathers.
Conclusion: These findings emphasize the importance of considering the psychosocial variables that
affect paternal psychological health. Mental health professionals may be able to reduce mental
disorders, stress, psychological distress, and marital maladjustment in fathers with appropriate
psychological interventions.

Keywords: Father; Depression; Postpartum Period; Psychology; Marital Relationship; Paternal Behavior

1 Introduction childbirth (3). Signs and symptoms of postpartum

Postpartum depression (PPD) is a frequent and severe
mental disorder that affects 12-20% of women after
labor (1). In Iran, the prevalence of this disorder has
been reported at 28.7% (interval of confidence 95%:
24/9-34/5 (2). Symptoms usually occur within the
first few weeks after delivery, but they may begin
during pregnancy or after it, up to one year after
Correspondence:
Dr. Nasrin Abedinia
Email: nasrin.abedinia@yahoo.com
depression may include depressed mood or severe
mood swings; excessive crying; lack of attachment to
the infant; isolation from family and friends; loss of
appetite or eating more than usual; insomnia or
somnolence; fatigue or loss of energy; loss of interest
in activities such as sex; severe irritability and anger;
fear of being a good mother; hopelessness; feeling
worthless; shame, guilt or inadequacy; apparent
decline of thinking ability, concentration or decision
making; restlessness; severe anxiety and panic
attacks; thoughts on self or child harm and recurrent

Copyright © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/).
Noncommercial uses of the work are permitted, provided the original work is properly cited.

272 Vol. 16, No. 4, December 2022 http://jfrh.tums.ac.ir Journal of Family and Reproductive Health 
 Paternal Postpartum Depression
thoughts of death or suicide (4). Depression in
mothers undermines the maternal role and results in a
reduction of the response to the infant's needs.
Evidence has suggested that treatment of maternal
depression can lead to growth, development, and a
decrease in the risk of diarrhea and malnutrition for
infants (5). PPD can also exacerbate parental stress
and lead to marital dissatisfaction as well as threaten
the health, well-being, and comfort of the family (6).
This matter can affect the health of fathers in the
transition phase to parenthood. In a meta-analysis
investigation on 43 studies, the prevalence of paternal
postpartum depression was 8.4%, which was higher
than the average male adult population (4.7%) (7).
Paternal depression results in a substantial economic
burden on societies, as it can impose substantial
economic and social costs on governments (1).
Studies show that paternal PPD has a negative impact
on family, marital relationships, and child
development. Not only does PPD have adverse
effects on early child development but also upon the
child's later physical and mental growth (8-10).
Maternal PPD is a well-known condition and has
been extensively investigated. In comparison,
paternal PPD and its potential effects on the family
have yet to be widely investigated and recognized
(11). PPD is associated with many common risk
factors such as depression, emotional stress, poor
economic and social conditions (12), anxiety, sleep
disorders (13), history of abortion, lifestyle, lack of
social support and history of psychological disorders
(14, 15). It has also been reported that there are
significant risk factors for paternal depression during
the phases of transition to parenthood including age,
education, history of psychiatric disorders, economic
problems, and maternal depression (16, 17). Maternal
depression has been identified as the most critical
predictor of paternal depression during the
postpartum period and has, therefore, been mentioned
in most studies (18, 19). Albeit this relation is
significant in the diagnosis and treatment of maternal
depression, however, it does not provide any sufficient
information regarding the diagnostic criteria of
paternal depression for early interventions (1).
Studies have indicated the importance and
necessity of health in the paternal psychological state
during the postpartum period. While paternal PPD
harms marital relationships, attachment, and infant
growth (20), there also seems to be a negative
relationship between postpartum depression and
paternal social support, though the number of such
 Journal of Family and Reproductive Health http://jfrh.tums.ac.ir
studies is limited (21).
Traditionally, most studies have been focused on
maternal PPD. In recent decades, however, more
attention is being paid to paternal PPD in the
literature, including issues of diagnosis, prevalence,
and impact on child behavior. Knowledge is growing
and expanding regarding paternal PPD, its
characteristics, risk factors, associated factors, impact
on the infant and child, and its relation with maternal
PPD. The incidence of paternal PPD in Iran may, like
maternal PPD, be high in prevalence; however, no
studies have been carried out on paternal PPD in Iran.
Severe economic crises in Iran have led to lower
household incomes, an increase in unemployment, and
a housing crisis. As a result, people are experiencing
serious economic stress factors. Therefore, identifying
predictors of PPD in fathers could facilitate the
development of diagnostic tools and therapeutic
interventions based on the needs of fathers.
Materials and methods
This study had a cohort study (a longitudinal study)
design. Data collected from April 2017 to May 2019.
Fathers in this study were selected from parents
that referred to hospitals in Tehran, including Vali
Asr Hospital (Imam Khomeini Hospital Complex)
and Milad Hospital. These hospitals are located in the
central and northern parts of Tehran and are child-
friendly hospitals. Vali ASR Hospital is a public
hospital affiliated with Tehran University of Medical
Sciences, and Milad Hospital is a public hospital
affiliated with the Insurance Agency that receives no
fees for provided services for its patients. Pregnant
women who came to the clinics for their routine
examinations during the last weeks of pregnancy
(from 35 weeks onwards) were provided with
complete information on the research project by the
secretaries of the pregnancy clinics so that their
spouses could participate in the study if they were
willing to do so. The names of fathers who were
willing to participate and had full information about
the study were collected. Entry criteria for
participation of fathers in the study included: (1)
literacy and knowledge of the Persian language; (2)
having no serious physical or mental illness, such as
psychosis, in either parent; (3) delivery after 36
weeks of pregnancy; (4) minimum neonatal weight of
2500 grams; and (5) no particular neonatal health
problems or need to be hospitalized in the neonatal
intensive care unit for more than 24 hours. For
implementation of the plan and completing the
Vol. 16, No. 4, December 2022 273
 Shariat et al.
questionnaires, researchers contacted all of the
participating fathers by telephone. Participants could
also refer to the research setting (hospitals) to
complete the questionnaires in oral sessions. A room
with adequate space was provided to meet fathers and
complete questionnaires at Vali Asr and Milad
hospitals (n = 215). Sixty-five fathers dropped out of
the study (30%). Sixty-nine percent (n = 45) of the
fathers refused to participate because of a lack of
interest in the study and its continuation; thirty-one
percent of them (n = 20) were interested in taking
part in the study but due to work involvement and
lack of time refused to participate.
Fathers who agreed to participate in the study all
met at the hospital with the researcher (n = 150), and
the researcher explained how and when to complete
the self-assessment questionnaires at three different
times: (1) late in pregnancy; (2) postnatal; and (3)
4 weeks after delivery. The minimum time estimated
to complete the questionnaires was 15 minutes and the
maximum was 90 minutes. The questionnaires were
given to the fathers in three separate envelopes with
the date of implementation on them. Participants were
asked to send questionnaires to the hospital after
completion. Gift cards of 50,000 tomān (US $12) were
given to fathers for the completion of questionnaires.
The Ethics Committee of Tehran University of
Medical Sciences approved this project (# 24057).
After a thorough explanation of the plan and its aims,
informed consent was obtained from the participators.
The Beck Depression Inventory (BDI) is a
self-scored scale containing 21 items. In this test the
key symptoms that are examined include mood,
pessimism, sense of failure, despair, guilt, punishment,
self-hatred, self-criticism, suicidal ideation, crying,
irritability, social withdrawal, poor decision making,
change in body image, difficulty at work, insomnia,
fatigue, loss of appetite, weight loss, burn out
syndrome, and loss of libido. The scoring scale is
presented in a multiple-choice format with numerical
values of 0-3 (0 = minimum, 3 = maximum) and the
possible total for the whole test is from zero to
sixty-three (22). (13 <Mild Depression, 19 < Moderate
Depression, and 28 <Severe Depression). The validity
and reliability of the questionnaires were 0.93 and
0.92, respectively, (Alpha=0.92) (23).
The Edinburgh Postnatal Depression Scale
(EPDS) is a postnatal rating scale for depression that
contains 10 items scored on a scale of 0-3 based on
the severity of depressive symptoms. Questions 1, 2,
and 4 are scored from 0 to 3 with the top box scored
274 Vol. 16, No. 4, December 2022 http://jfrh.tums.ac.ir
as 0 and the bottom box scored as 3, and Questions
3, 5, 6, 7, 8, 9, and 10 are reverse scored from 3-0.
The score range is from 0-30 (24). The cut-off score
of the questionnaire is equal to or greater than 12
(12 ≤), and its Cronbach's alpha value is 0.70 (25).
The Dyadic Adjustment Scale (DAS) includes
32 items, which evaluates marital satisfaction over
the prior 12 months (26). This scale has 4 subsets of
the main scale: (1) Dyadic Consensus, comprising
13 items that ask participants to agree or disagree on
a number of issues; (2) Dyadic satisfaction, which
includes 10 items that evaluate aspects of perceived
stability of marriage and how to manage problems
and disputes; (3) Affectional Expression, containing
4 items that examine the degree of accord on how
emotions are expressed; and (4) Bilateral Dyadic
Cohesion, consisting of 5 items that distinguish the
frequency of interactions between couples. Higher
scores demonstrate a higher quality of marital
relationships. The internal consistency of this scale is
0.91, (Alpha=0.80) (27).
The Parent Expectations Survey (PES) is used to
measure perceptions of self-efficacy immediately
after entering parenthood (28). The Parent
Expectations Survey contains 25 statements each
rated from 0-10. The sum of the scores represents the
mean of all expressions. The highest score indicates a
greater perception of parental efficacy. The internal
stability is PES 0.90, (Alpha=0.70) (1).
One of the most common measurements for stress
is the Parenting Stress Index (PSI), a 120-item
questionnaire developed by Abidin in 1995 (29). The
short form of this questionnaire (PSI-Sf), based on the
long form, contains 36 parental self-reported items that
are scored based on the Likert scale from 1-5. The
questionnaire has three subscales and each of these has
12 items and a score range from 12-60. Higher scores
indicate an increase in parental stress. The three
subscales include: (1) the Parental Distress (PD) scale
which indicates parental distress based on the parental
role-the PD factor indicates 12.2% of parental stress
and the Cronbach's alpha is 0.82; (2) the Difficult
Child (DC) scale which is for children who are
difficult to take care of-the DC factor includes 13.2%
of parental stress and the Cronbach's alpha is 0.83);
and (3) the Parent-Child Dysfunctional Interaction
(P-CDI) scale which manifests 12.6% of parental
distress and has a Cronbach's alpha of 0.78 (1,30).
The Multidimensional Scale of Perceived Social
Support (MSPSS) has been developed to measure
perceived social support from family, friends, and
Journal of Family and Reproductive Health 
 Paternal Postpartum Depression

influential people in life (31) and this tool consists of adequate income levels. Of these, 66.7% of the
12 items each of which has a range from 1-7 fathers (100 persons) were working for the
(1 = strongly disagree to 7 = strongly agree). For the government and 33.3% of them (50 persons) had
total score, the scores of all the items are summed up private or freelance jobs. Duration of married life
and divided by the number of items (12). The score of ranged from 2 to 19 years with a mean and standard
each subscale is also obtained by summing the scores of deviation of M = 7; SD = 4.24; the most frequent
the items divided by the number of items (4). The duration was 6 years or less (53.3%). Results showed
reliability of the scale using the Cronbach's alpha that 56.7% of fathers (n = 85) were experiencing
coefficient for the three subscales (family, friends, fatherhood for the first time, 33.3% (n = 50) had one
important people in life) and the total score were child, and 10% (n = 15) had two children before the
reported at 0.89, 0.90, 0.90, and 0.94, respectively (32). birth of their newborn. According to reports given by
Information such as paternal age (≤34 vs. > 34 the fathers, 86.4% (95) of mothers had a cesarean
years), level of education (university education vs. no section while 13.6% (15) of mothers had a normal
university education), father's job (public vs. private), delivery. Fathers who reported a history of abortion
socioeconomic class (low and medium vs. good), comprised 46.7% (70 women) of which 16.7%
duration of marriage (≤6 vs. >6 years), having/ (25 women) experienced abortion once, 23.3%
not having children and number of children (1 child (35 women) twice, 3.3% (5 women) three times and
vs. 2 children), type of delivery (normal vs. cesarean 3.3% (5 women) four times. The results demonstrated
section), having/not having an abortion before birth that 50% of infants (75 persons) were female and half
and the number of abortions (once versus more than were male. Sixty-five parents dropped out of the
once)was obtained from the demographic study due to work difficulties and lack of interest in
characteristics of the father’s questionnaire and the completing the questionnaires (Table 1).
data was encoded. It should be noted that 40 fathers
did not report the type of delivery while only 110 Table 1: Characteristics of the sample
fathers did indicate this on the questionnaire. Variables Variables Total (n=150) %
with more than 3 categories and continuous variables Age of the Father
were divided into 2 categories based on the median. ≤ 34 years (22-34 years) 51.3% (77)
Data were analyzed with using descriptive > 34 years (35-48 years) 48.7% (73)
statistics (frequency, percentage, mean and standard Level of education
< University 50% (75)
deviation) and correlational statistics (chi-square test
≥ University 50% (75)
and t-test 2 independent samples) the relationship
Job of the Father
between postpartum depression and psychosocial Government Job 66.7% (100)
factors and demographic characteristics and Private Job 33.3% (50)
dependent sample t-test for measuring the relation Socio-economic Level
between the tests in two stages of after birth and one Low & Medium 53.3% (80)
month after childbirth. And also using SPSS Good 46.7% (70)
software (version 20.0 Armonk, NY: IBM Corp). Duration of marriage
≤ 6 years (2-6 years) 53.3% (80)
Results > 6 years (7-19 years) 46.7% (70)
The samples included 150 fathers who participated in Having child 43.3% (65)
Number of child
the study. These fathers had a mean age of M = 34.44
One child 33.3% (50)
(SD = 5.14) and an age range of 22-48 years. The
Two children 10% (15)
highest frequency in age was 34 and 51.3% were Type of delivery
under this age. Regarding educational level, 10.7% Natural 13.6% (15)
(n = 16) were under high school level, 39.3% (n = 59) Cesarean 86.4% (95)
had a diploma and 50% (n = 75) had bachelor's Abortion experience (yes) 46.7% (70)
degrees or above. In determining the socio-economic Once (Abortion) 16.7% (25)
level based on income, 3.3% (5 persons) had low and More than once (Abortion) 30% (45)
inadequate income, 50% (75 persons) were at the
middle-income level, and 46.7% (70 persons) had The results regarding the relationship between the

 Journal of Family and Reproductive Health http://jfrh.tums.ac.ir Vol. 16, No. 4, December 2022 275
 Shariat et al.

demographic variables of prenatal depression and
postnatal depression showed that there were no
significant differences between depressed and
non-depressed groups using the Beck (prenatal) and
Edinburgh (postnatal) tests, and the groups were
identical. The Beck Depression Inventory assessed
paternal depression at 35 weeks and late pregnancy.
The results showed that 38.7% (58 fathers) had signs
of depression, and it was mild depression. In addition,
the Edinburgh Postnatal Depression Questionnaire
assessed paternal depression for two time frames
(after birth and four weeks after birth). Results
showed that 30% (45 fathers) had depressive
symptoms the second stage and had depression
28% (42 fathers) in the third time. The prevalence
and frequency of depression appeared to be the same
at all three periods (prenatal, postnatal, and four
weeks postpartum) and did change over time.
In analyzing the data of psychosocial variables at
the two stages of postnatal and one month after birth,
the results showed that paternal depression decreased
one month after childbirth in comparison to the
postnatal stage and this difference was statistically
significant (M = 4.80 VS M = 4.47; P = 0.018). In
addition, according to fathers’ reports, infant care
ability (parental expectations) increased one month
after delivery with a statistically significant
difference (M = 169.20 VS M = 177.00; P ≤ 0.0001).
Finally, paternal stress had a decrease that was
statistically significant (M = 73.13 VS M = 69.40;
P ≤ 0.0001) by the one-month-after-birth time frame
in comparison to the postnatal stage. Other
psychosocial variables such as marital compatibility
and parental support had no statistically significant
difference among fathers at the two stages of
postnatal and one month after birth (Table 2).
There was no significant difference in parental
expectations and perceived social support between
the two groups of depressed and non-depressed
fathers (Table 3).
Discussion
The results showed that the prevalence of
postpartum depression in fathers was from 38.7% to
28% based on EPDS and BACK. These statistics
show that the rate of postpartum depression among
Iranian fathers and other studies with a prevalence
of 3 to 12% (33,34). Therefore, shows that The
prevalence of depression in Iranian fathers is higher
than other studies .It may be due to severe economic
problems in the country. In the general population,
the prevalence of mood disorders was reported to be
14.6%, major depressive disorder in men 10.2%, and
depression in adult men 10% (35). According to the
presented statistics, it seems that paternal depression
is more than the average population and depression
among men in Iran increases with pregnancy and
has a high prevalence. The results of this study
showed that psychological factors, such as marital
adjustment four weeks after Birth is significantly
associated with paternal depression. Other studies
have shown that spousal depression and low marital
satisfaction are significantly associated with
postpartum depression one-month postpartum (36).
Shorey reported marital dissatisfaction and sexual
needs, it is effective in postpartum depression for
parents (37). The results of the present study showed
that fathers in the depressed group had more stress
than the non-depressed group after delivery.
Previous studies demonstrated that psychological
distress was significantly associated with
postpartum depression (38) and that fathers who had
stress or poor physical health were exposed to
depressive symptoms. Increased symptoms of
postpartum depression are associated with various
social and psychological factors (33).

Table 2: Mean and standard deviation of psychosocial variables at two

stages after birth and one month after birth in the study group
Variables M ± SD t P
Edinburgh Postnatal Depression Scale (1) 4.80 ± 5.12 2.39 0.018
Edinburgh Postnatal Depression Scale (2) 4.47 ± 4.59
Dyadic Adjustment Scale (1) 121.00 ± 15.75 0.29 0.769
Dyadic Adjustment Scale (2) 120.76 ± 15.99
The Parent Expectations Survey (1) 169.20 ± 47.16 3.72 0.0001
The Parent Expectations Survey (2) 177.00 ± 42.37
Parenting Stress Index (1) 73.13 ± 25.81 4.77 0.0001
Parenting Stress Index (2) 69.40 ± 25.82
Multidimensional Scale of Perceived Social Support (1) 63.00 ± 13.22 0.172 0.864
Multidimensional Scale of Perceived Social Support (2) 62.93 ± 13.42

276 Vol. 16, No. 4, December 2022 http://jfrh.tums.ac.ir Journal of Family and Reproductive Health 
 Paternal Postpartum Depression

Table 3: Associations between psychosocial variables and paternal postnatal

depression according to the Edinburgh Postnatal Depression Scale (EPDS)
Variables Non-depressed (M ± SD) Depressed (M ± SD) t P
DASa (After birth) 122.70 ± 15.30 105.67 ± 10.90 4.19 0.324
DAS (A month after birth) 122.59 ± 15.51 104.33 ± 9.87 4.45 0.043
PESb (After birth) 176.96 ± 42.36 99.33 ± 26.27 6.94 0.197
PES (A month after birth) 181.96 ± 39.69 132.33 ± 40.61 4.58 0.683
PSIc(After birth) 69.22 ± 24.18 108.33 ± 4.17 - 6.23 0.010
PSI (A month after birth) 66.04 ± 24.58 99.67 ± 14.89 - 5.18 0.444
MSPSSd (After birth) 63.78 ± 13.06 56.00 ± 13.01 2.19 0.681
MSPSS (A Month after birth) 63.55 ± 13.24 57.33 ± 14.25 1.71 0.304
a
Dyadic Adjustment Scale (DAS), bThe Parent Expectations Survey (PES), cParenting Stress Index (PSI),
d
Multidimensional Scale of Perceived Social Support (MSPSS)

The results of the present study indicated that
paternal depression and stress decreased one month
after birth while parental self-efficacy in parenthood
increased during the month after childbirth.
This study investigates the psychosocial factors
connected to paternal depression, such as marital
adjustment, parental expectations, social support, and
psychological stress, which lead to an increase of
awareness and understanding of paternal depression.
Reports have suggested that postpartum depression is
associated with poor marital relationships (39, 40).
Experts in the psychological health field have
suggested that parental mental health and marital
relations should be considered. Identifying the factors
associated with paternal depression, which can lead
to the prevention of marital dissatisfaction or increase
the quality of marital relations, is vital for the
prevention and early detection of paternal depression
(36). Paternal depression is associated with a history
of mental disorders, psychological distress during
pregnancy, low income, unemployment, maternal
postpartum depression, and neonatal diseases that are
undergoing medical treatment (38). Psychosocial
variables should be considered as effective risk
factors in early screening and targeted prevention is
available for fathers who are at risk of depression
during the transition to parenthood (41). Professionals
need to develop training packages that help spouses
achieve marital satisfaction and its positive
consequences on psychological health, which include
models of healthy communication between couples
during pregnancy to one year after childbirth, and
provide these training packages to health care
providers so they can present them to those in need of
marital counseling services.
Stress, anxiety, and depressive symptoms have
been reported in fathers during the transition to
parenthood. Findings show that symptoms of anxiety
related to postpartum depression are more than
depression unrelated to the postnatal phase and
generalized anxiety after delivery is more common
than postpartum depression (42-44). Paternal anxiety
increases before and during delivery and decreases
after childbirth. Paternal anxiety has a negative
impact on the father's psychological health, physical
health, social relationships, and parental skills and
causes stress, depression, fatigue, and decreased
paternal self-efficacy (45). Depression and stressful
responses of the father may affect the family
environment and, ultimately, the growth of the child
and adolescent. Findings have indicated that
symptoms of paternal depression and father-child
conflicts are associated with emotional and
behavioral problems in children, which may have
been brought about through negative parenting.
Preventive interventions focused on symptoms of
paternal depression, and father-child conflict should
be considered (46-48).
Investigations in most studies focus on maternal
depression, and few studies have focused on paternal
psychological health and how it affects children.
Therefore, further studies are needed to investigate
the prevalence of psychiatric disorders and their
related factors in fathers. Men generally tend to be
treated less; however, they may be more willing to
have their symptoms of depression treated if they are
aware of the positive effects of treatment on their
child. Thus, health care providers and professionals
who are dealing with children and families should
encourage fathers to promote the psychological
health of all family members (49). In addition, it
seems that systemic collaboration is possible between
mental health professionals and gynecologists-
midwives in the procedure of postpartum depression
treatment, and therapeutic and psychological services
could be provided immediately after delivery to

 Journal of Family and Reproductive Health http://jfrh.tums.ac.ir Vol. 16, No. 4, December 2022 277
 Shariat et al.
depressed mothers and mothers who are hospitalized
(50). Unfortunately, during pregnancy, only the
physical and mental health of the mother is
considered, and the mental health of fathers is not
examined; as a result, the diagnoses of anxiety, stress
and emotional problems of fathers are neither
common nor taken seriously by medical professionals
and health care providers (51). It seems that
professionals and health care providers do not have
the knowledge, cognition, and planning necessary to
provide health care to fathers and their needs are
neglected (1). Given the importance of family health
and the lack of information on paternal postpartum
depression, especially in developing countries,
paternal mental health screening during the prenatal
stage (even before pregnancy) should be performed
(52). Various studies have indicated that potential
psychological therapies include cognitive-behavioral
therapy (CBT); group work; electronic support
(e-support); and psychotherapy interventions for
incompatibilities and cognitive distortions related to
masculine identity, masculine role expectations, and
feelings of isolation and rejection are effective in
promoting paternal mental health in the perinatal and
postpartum periods (53). It also appears that parental
involvement, especially of fathers, in parenting can
lead to a sense of self-efficacy, increased levels of
social cohesion, reinforcement of self-perception of
skills, and confidence in parents of young children. In
addition to these, an increase in individual and group
adaptation, reduction of anxiety, and no used merely
limited and specific solutions to solve problems (54).
In one qualitative study, it was reported that a lack of
awareness by fathers regarding postpartum paternal
depression (PPD) leads to inappropriate assessment
and diagnosis of PPD. Fathers acknowledged that an
increase in the awareness of the community could
encourage treatment. Experts believe that supportive
resources should be provided to men as the first step
to encouraging treatment and identifying treatment
priorities in men (51). We suggested for future
research such as having qualitative in-depth
interviews from Iranian fathers to understand their in-
depth emotional needs.
Strengths and Limitations: This study
investigated the psychological factors affecting
paternal depression postnatal and one month
postpartum. As no prior research has been done on
paternal depression in our country, this is the first
study in this field. The fathers who participated in
this study appeared to have no psychological
278 Vol. 16, No. 4, December 2022 http://jfrh.tums.ac.ir
problems. BDI (late pregnancy) and EPDS
(postpartum) questionnaires were used as tools for
screening and identifying signs and symptoms of
depression in fathers. It should be noted that fathers
who received a score of 14 on the BDI or a score of
12 on the EPDS via face-to-face interviews, were
given information about psychological health so they
could use psychological services if they desired.
One of the limitations of this study was the selection
of individuals using the available sampling method,
which may not lead to the same chance of presences all
of the fathers generally with different experiences.
Another limitation of this study was sampling
from public hospitals in Tehran, where people from
different socioeconomic classes referred, and no
sampling was done in private hospitals in Tehran.
This study needs to be repeated with a variety of
samples from different private and public centers.
Another limitation of this study, which is related
to cultural issues in our country, is the unwillingness
of men to complete questionnaires. Also, due to the
large number of questionnaires, there is a possibility
that the questionnaires may not have been completed
correctly. It seems that the use of diagnostic
interviews and oral questioning is the best option for
conducting studies on men in our country.
Conclusion
This study demonstrated that paternal depression was
significantly associated with some psychological
variables such as marital adjustment and stress. Also,
depression, efficacy, or parental expectations and
paternal stress were assessed at two stages of
postnatal and one month postpartum. The results
showed that paternal depression and stress decreased
over time, while fathers’ parental efficacy in caring for
their children increased. These findings indicate the
importance of screening for postnatal depression in
fathers. Given the importance of this subject, it seems
that screening should take place not only from the time
of pregnancy but also until at least one year after
childbirth. Paternal depression affects psychological
components such as mental health, stress, marital
relations, quality of life, and relations or interaction
with the child; therefore, psychology professionals
should pay special attention to the mental health of
fathers. Improving the psychological health of the
father can lead to the health of the whole family.
Conflict of Interests
All authors declare that they have no conflict of interest.
Journal of Family and Reproductive Health 
 Paternal Postpartum Depression
Acknowledgments
The researchers express their gratitude to the
Research Deputy of the Tehran University of Medical
Sciences, Tehran (TUMS), Iran, for financial support
and scientific-ethical confirmation of the approved
project, numbered 24057. We also appreciate all the
staff members of Vali-e-Asr Hospital and Milad
Hospital for their assistance in the implementation of
the study.
References
1. Demontigny F, Girard ME, Lacharité C, Dubeau D,
Devault A. Psychosocial factors associated with
paternal postnatal depression. J Affect Disord 2013;
150: 44-49.
2. Veisani Y, Sayehmiri K. Prevalence of Postpartum
Depression in Iran - A Systematic Review and Meta-
Analysis. The Iranian Journal of Obstetrics,
Gynecology and Infertility 2012; 15; 21-9.
3. Choi KW, Sikkema K J, Vythilingum B, Geerts L,
Faure SC, Watt MH, et al. Maternal childhood trauma,
postpartum depression, and infant outcomes: Avoidant
affective processing as a potential mechanism. J Affect
Disord 2017; 211:107-15.
4. Lieber A. A Guide to Common Depression after
Childbirth. Postpartum Depression (PPD).2019.
https://www.psycom.net/depression.central.post-
partum.html
5. Irvine A, Rawlinson C, Bor W, Hoehn E. Evaluation of
a collaborative group intervention for mothers with
moderate to severe perinatal mental illness and their
infants in Australia. Infant Ment Health J, 2021; 42(4):
560-572.
6. Zhang YP, Zhang LL, Wei HH, Zhang Y, Zhang CL,
Porr C. Postpartum depression and the psychosocial
predictors in first-time fathers from northwestern
China. Midwifery 2016; 35: 47-52.
7. National Institute of Mental Health, 2015. Major
Depression Among Adults. Available at:
〈https://www.nimh.nih.gov/health/statistics/prevalence/
major-depression-amongadults. shtml〉. (Accessed 12
December 2016).
8. Cummings EM, Keller PS, Davies PT. Towards a
family process model of maternal and paternal
depressive symptoms: exploring multiple relations with
child and family functioning. J Child Psychol
Psychiatry 2005; 46: 479-89.
9. Feldman R, Edelman Arthur I. Parent-Infant Synchrony
and the Social-Emotional Development of Triplets.
Dev Psychol 2004; 40: 1133-47.
 Journal of Family and Reproductive Health http://jfrh.tums.ac.ir
10. Solantaus T, Salo S. Paternal postnatal depression:
fathers emerge from the wings. Lancet 2005; 365:
2158-9.
11. Musser AK, Ahmed AH, Foli KJ, Coddington JA.
Paternal postpartum depression: what health care
providers should know. J Pediatr Health Care 2013; 27:
479-85.
12. Swenson CW, DePorre JA, Haefner JK, Berger MB,
Fenner DE. Postpartum depression screening and
pelvic floor symptoms among women referred to a
specialty postpartum perineal clinic. Am J Obstet
Gynecol 2018; 218: 335.e1-335.e6.
13. Tham EK, Tan J, Chong YS, Kwek K, Saw SM, Teoh
OH, et al. Associations between poor subjective
prenatal sleep quality and postnatal depression and
anxiety symptoms. J Affect Disord 2016; 202: 91-4.
14. Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi
A, Bahrami M. Postpartum depression risk factors: A
narrative review. J Educ Health Promot 2017;6:60.
15. Fellmeth G, Opondo C, Henderson J, Redshaw M,
McNeill J, Lynn F, et al. Identifying postnatal depression:
Comparison of a self-reported depression item with
Edinburgh Postnatal Depression Scale scores at three
months postpartum. J Affect Disord 2019; 251:8-14.
16. Wee KY, Skouteris H, Pier C, Richardson B, Milgrom J.
Correlates of ante- and postnatal depression in fathers: a
systematic review. J Affect Disord 2011; 130:358-77.
17. Cameron E E, Sedov I D, Tomfohr-Madsen L M.
Prevalence of paternal depression in pregnancy and the
postpartum: an updated meta-analysis. Journal of
Affective Disorders 2016; 206: 189–203.
18. Escribà-Agüir V, Artazcoz L. Gender differences in
postpartum depression: a longitudinal cohort study.
J Epidemiol Community Health 2011; 65: 320-6.
19. Goodman J H. Paternal postpartum depression, its
relationship to maternal postpartum depression, and
implications for family health. J Adv Nurs.2004; 45:
26-35.
20. Suto M, Takehara K, Yamane Y, Ota E. Effects of
prenatal childbirth education for partners of pregnant
women on paternal postnatal mental health and couple
relationship: A systematic review. J Affect Disord
2017; 210: 115-21.
21. Kamalifard M, Hasanpoor S, Babapour Kheiroddin J,
Panahi S, Bayati Payan S. Relationship between Fathers'
Depression and Perceived Social Support and Stress in
Postpartum Period. J Caring Sci 2014; 3: 57-66.
22. Thiruchselvam T, Dozois DJ A, Bagby R M, Lobo
DSS, Ravindran LN, Quilty LC. The role of outcome
expectancy in therapeutic change across psychotherapy
versus pharmacotherapy for depression. J Affect Disord
Vol. 16, No. 4, December 2022 279
 Shariat et al.
2019: 251: 121-9.
23. Dabson K S, Mohammad Khani P. Psychometric
Characteristics of Beck Depression Inventory II in
Patients with Major Depressive Disorder. Journal of
Rehabilitation 2007;8: 82-88.
24. Gollan JK, Wisniewski SR, Luther JF, Eng HF, Dills
JL, Sit D, Ciolino JD, Wisner KL. Generating an
efficient version of the Edinburgh Postnatal Depression
Scale in an urban obstetrical population. J Affect
Disord 2017; 208:615-20.
25. Ahmadi kani Golzar A, GoliZadeh Z. Validation of
Edinburgh Postpartum Depression Scale (EPDS) for
screening postpartum depression in Iran. IJPN 2015;
3:1-10.
26. Spanier GB. Measuring dyadic adjustment: New scales
for assessing the quality of marriage and similar dyads.
Journal of Marriage and Family 1976; 38; 15–28.
27. South SC, Krueger R F, Iacono WG. Factorial
invariance of the Dyadic Adjustment Scale across
gender. Psychol Assess 2009; 21: 622-8.
28. Reece SM. The parents’ expectations survey: a measure
of perceived self-efficacy. Clin Nurs Res 1992; 1: 336–
46.
29. Abidin R R. Parenting Stress Index: Manual.
Psychological Resources, Odessa, Florida 1995.
30. Barroso NE, Hungerford GM, Garcia D, Graziano PA,
Bagner DM. Psychometric properties of the Parenting
Stress Index-Short Form (PSI-SF) in a high-risk sample
of mothers and their infants. Psychol Assess 2016; 28:
1331-35.
31. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The
Multidimensional Scale of Perceived Social Support.
Journal of Personality Assessment 1988; 52:30-41.
32. Alipour A, Aliakbari Dehkordi M, Amini F, Hashemi
Jashni. Relationship between perceived social support
and adherence of treatment in Diabetes mellitus type 2:
mediating role of resillency and hope. Journal of
Research in Psychological Health 2016; 10: 53-67.
33. Underwood L, Waldie KE, Peterson E, D'Souza S,
Verbiest M, McDaid F, et al. Paternal Depression
Symptoms During Pregnancy and After Childbirth
Among Participants in the Growing Up in New Zealand
Study. JAMA Psychiatry 2017;74: 360-9.
34. Takehara K, Suto M, Kakee N, Tachibana Y, Mori R.
Prenatal and early postnatal depression and child
maltreatment among Japanese fathers. Child Abuse
Negl 2017; 70: 231-39.
35. Montazeri A, Mousavi SJ, Omidvari S, Tavousi M,
Hashemi A, Rostami T. Depression in Iran: a
systematic review of the literature (2000-2010). Payesh
2013; 12: 567-94.
280 Vol. 16, No. 4, December 2022 http://jfrh.tums.ac.ir
36. Nishimura A, Fujita Y, Katsuta M, Ishihara A, Ohashi
K. Paternal postnatal depression in Japan: an
investigation of correlated factors including
relationship with a partner. BMC Pregnancy Childbirth
2015; 15: 128.
37. Shorey S, Ang L, Goh ECL, Lopez V. Paternal
involvement of Singaporean fathers within six months
postpartum: A follow-up qualitative study. Midwifery
2019; 70: 7-14.
38. Nishigori H, Obara T, Nishigori T, Metoki H, Mizuno
S, Ishikuro M & et al. The prevalence and risk factors
for postpartum depression symptoms of fathers at one
and 6 months postpartum: an adjunct study of the Japan
Environment & Children's Study. J Matern Fetal
Neonatal Med 2020; 33: 2797-804.
39. Matthey S, Barnett B, Ungerer J, Waters B. Paternal
and maternal depressed mood during the transition to
parenthood. J Affect Disord 2000; 60: 75–85.
40. Ramchandani PG, Psychogiou L, Vlachos H, Iles J,
Sethna V, Netsi E, et al. Paternal depression: an
examination of its links with father, child and family
functioning in the postnatal period. Depress Anxiety
2011; 28: 471–7.
41. Da Costa D, Danieli C, Abrahamowicz M, Dasgupta K,
Sewitch M, Lowensteyn I, et al. A prospective study of
postnatal depressive symptoms and associated risk
factors in first-time fathers. J Affect Disord 2019;
249:371-77.
42. Wenzel A, Haugen EN, Jackson LC, Robinson K.
Prevalence of generalized anxiety at eight weeks
postpartum. Arch Womens Ment Health.2003;6:43-9.
43. Ross LE, Gilbert Evans SE, Sellers EM, Romach MK.
Measurement issues in postpartum depression part 1:
anxiety as a feature of postpartum depression. Arch
Womens Ment Health 2003; 6: 51-7.
44. Vismara L, Rollè L, Agostini F, Sechi C, Fenaroli V,
Molgora S, et al. Perinatal Parenting Stress, Anxiety,
and Depression Outcomes in First-Time Mothers and
Fathers: A 3- to 6-Months Postpartum Follow-Up
Study. Front Psychol 2016; 7: 938.
45. Philpott LF, Savage E, FitzGerald S, Leahy-Warren P.
Anxiety in fathers in the perinatal period: A systematic
review. Midwifery 2019; 76: 54-101.
46. Gutierrez-Galve L, Stein A, Hanington L, Heron J,
Ramchandani P.Paternal depression in the postnatal
period and child development: mediators and
moderators. Pediatrics 2015; 135: e339-47.
47. Nath S, Russell G, Kuyken W, Psychogiou L, Ford T.
Does father-child conflict mediate the association
between fathers' postnatal depressive symptoms and
children's adjustment problems at 7 years old? Psychol
Journal of Family and Reproductive Health 
 Paternal Postpartum Depression
Med 2016; 46: 1719-33.
48. Sweeney S, MacBeth A. The effects of paternal
depression on child and adolescent outcomes: A
systematic review. J Affect Disord 2016; 205: 44-59.
49. Tichovolsky MH, Griffith SF, Rolon-Arroyo B, Arnold
DH, Harvey EA. A Longitudinal Study of Fathers' and
Young Children's Depressive Symptoms. J Clin Child
Adolesc Psychol 2018; 47: S190-S204.
50. Šebela A, Hanka J, Mohr P. Diagnostics and modern
trends in therapy of postpartum depression. Ceska
Gynekol 2019; 84: 68-72.
51. Cameron E E, Hunter D, Sedov ID, Tomfohr-Madsen
LM. What do dads want? Treatment preferences for
paternal postpartum depression. J Affect Disord 2017;
215: 62-70.
52. Ayinde O, Lasebikan VO. Factors associated with
paternal perinatal depression in fathers of newborns in
 Journal of Family and Reproductive Health
Nigeria. J Psychosom Obstet Gynaecol 2019; 40: 57-65.
53. O'Brien AP, McNeil KA, Fletcher R, Conrad A, Wilson
A J, Jones D, et al. New Fathers' Perinatal Depression
and Anxiety-Treatment Options: An Integrative Review.
Am J Mens Health 2017; 11: 863-76.
54. Sinclair F, Naud J.Social support and emergence of a
feeling of parental efficiency: a pilot study on the
contribution of the EcoFamille program. Sante Ment
Que. 2005;30 :193-208.
Citation: Shariat M, Abedinia N, Charousaei H,
Fatahi F. The Relationship Between Paternal
Postpartum Depression and Psychosocial
Variables: A longitudinal Study in Iran. J Family
Reprod Health 2022; 16(4): 272-81.
http://jfrh.tums.ac.ir Vol. 16, No. 4, December 2022 281